Study Finds Nerve Blocks Risky

Study Finds Nerve Blocks Risky

Sedating a patient before a nerve block increases the cost and raises the risk of unnecessary surgeries, while doing nothing to control long-term pain, according to a new study by a Johns Hopkins researcher.

“Sedation doesn’t help, but it does add expense and risk,” says study leader Steven P. Cohen, MD, a professor of anesthesiology at the Johns Hopkins University School of Medicine. “In some places, every patient is being sedated. Our research shows it should be used very sparingly.”

Results of the study, reported online in the journal Pain Medicine, show that sedation before a nerve block significantly increases false-positive results, which means patients are more likely to be sent in for surgeries and other procedures that won’t cure the underlying pain.

bigstock-back-pain-16821887Nerve blocks are often performed by injecting steroids or analgesics such as Lidocaine into a pain patient prior to a diagnostic procedure used to find the nerve that’s causing their pain. If the injection works, that nerve may then be chosen for an epidural steroid injection or some other treatment.

Researchers at Johns Hopkins and several other medical centers in the U.S. recruited 73 patients with back or limb pain who were scheduled to receive multiple nerve blocks. Half of the patients received the first injection with sedation and the second without. The remaining patients received their injections in the opposite order.

Patients were given pain diaries to determine whether the injections brought pain relief. They were also seen a month later and asked to rate their pain and function after the treatment.

Although the sedated patients reported less pain immediately after the nerve block injection, on every other measure — from 30-day pain assessments to overall patient satisfaction — the results were the same whether or not they were sedated.

“A lot of cost for very little benefit,” Cohen says.

If patients believe that the nerve block eased their underlying pain, physicians will often conclude that they have found the source and will move ahead with treatment, which may include spinal fusion or radiofrequency ablation of nerves for arthritis.  But Cohen says many patients wind up back at square one — still in pain, but having suffered through a potentially unnecessary operation.

Cohen says that while many physicians use sedation to make diagnostic procedures less traumatic for patients, there is also a financial incentive to use it.

“Unfortunately, medicine in many places has become a business. The fact is, you get paid more money to do the procedure with sedation,” he says. “The costs of anesthesia can be more than the fee for the procedure itself. And patients are getting harmed.”

“Nerve blocks are yet another band aid approach that leads to more imaging and damaging procedures,” says Dawn Gonzalez, whose spine was damaged by an epidural during child birth. She now suffers from arachnoiditis and is an advocate for Arachnoiditis Society for Awareness and Prevention (ASAP).

“If steroids are used, it causes the same tissue, bone, and muscle degradation issues and risks of fracture and osteoporosis as steroid injections. The risks are too many and too large for temporary relief. This has been a common treatment for Reflex Sympathetic Dystrophy (also known as Complex Regional Pain Syndrome) until recently, but has been proven to be ineffective and risky. It can cause worsening rather than relief.”

Epidural steroid injections are increasingly being used to treat back pain of all kinds, with nearly 9 million spinal injections in the U.S. in 2011. Several previous studies have found that steroid injections increase the risk of spinal fracture and do little to relieve back pain.

Authored by: Pat Anson, Editor

newest oldest
Notify of

I was diagnosed with herniated lumbar disc’s from the top of my
Spine to my hip. I was given my first nerve block which I think 8
Shots. I was not given any sedation. He said before he put the
Needle in it would alittle sting. But when he got to the hip area
With the needle I almost came off that table. Talk about hurt that
Hurt like hell!! He said that’s why he had his hand on my back
Because I jumped. Everything seemed ok until he got to the hip
Area that is when I jumped. Good thing I brought my Cain with me
So I could balance myself. I was kind of groggy driving my car
Home but I made it home ok. The nerve block didn’t work it felt at
At first it was working because my pain level went from a 10 when
I got there to a 3 when I got home. The next procedure they want
To do is Radio Frequncy Neurotomy which they will be
Deadening the nerve so the pain won’t go to the brain. I’m 60 yrs
Old and these procedures are hard on me. I hope this time it
Works because I don’t know how much more I can take. Thanks
For taking the time to reading my comment.

I have had 6 lower back surgeries and one cervical fusion. Since 1984 I have probably had 30 injections. I would honestly say only 6 or 7 gave me any relief past 7 days. We all look for the “magic pill” to fix us – took me a long time to realize, we can’t be fixed. Most of my injections were to roll onto my side, hold my knees and be very still. I have had 4 where I was put to sleep because they were cervical related and they were guided by machines . All I know is the 4 for my cervical worked for months each time. Was it because it was a different area ? I have to sign forms all the time because the insurance thinks I should have alternate insurance. I do not – I do not draw disability because I didn’t have a paying job and I am only 55 right now. I don’t have the answer to the side effects, but at what point do we get help ? We all have to depend on our Ortho and Neuro doctors – what are we, as the pain suffers supposed to do? Who do we trust??

Donna- my experience with pain management has been like you described. I was given 23 days worth of medication so I had to go in every 23 days for a $300 visit when it should have been once a month. Then I was given multiple urine tests because they couldn’t find a record of my first 2, all came back fine but my insurance co was billed for each one, so there was some record I had the test . . . but, regarding the article, if sedation helps a patient get through a procedure that may help them, great. Let them have it. If they don’t want it, let them try it without it. Don’t we all suffer enough?

These Nerve Blocks and or Epidural Steroid Injections should be banned! They are a preamble to back fusion surgery and disability. They are a misguided attempt to treat a problem that does not exist based on the descriptions used to explain the pain.
1. You can’t see pain with a scanner which they use to determine where to inject.
2. Steroids caustic to the tissue of the spinal column. They will cause a type of atrophy called Lipodystrophy and irritate and inflame the linings around the spine called Arachnoiditis. google those words.
3. Pain does not emanate from the spine, nerve or disc anyway so why treat these structures.
4. There are other simple safe vetted and more natural therapeutic options which are myofascial release therapy with hands-on and needles
5. The consent form you signed is probably incomplete and will misguide you to this procedure which is misinformed consent and I would suggest you consult with an attorney.

The issue with any procedure is that too many times it becomes standard protocol without taking a patient’s individual needs in mind. Combine this with the profit aspect of, say first providing sedation it’s just more money spent–especially since for many now because of the new healthcare, sedating before may become more commonplace.
I, for one, would like some sedation first if the nerve block was going to be painful.

Has Steven P. Cohen actually received a nerve block without sedation? I bet he hasn’t. Hurts like holy hell! I’ll never get one again without being sedated, and I need them on a fairly regular basis. It’s true, they only work for a limited time, but during the time that they work, my life is literally transformed! Without that nerve block, I’m tied to a walker, and have been for years. I’m 46. With the nerve block, I can get around just fine with only my cane for balance, and my back is pain-free while it lasts. It’s a blessing that I won’t give up on, and my pain docs aren’t forcing me to do it. I wish it had been suggested years ago!

Donna- It is cruel and degrading-but not surprising as I work with people in pain on a regular basis. Pain care in the U.S. is “a Willowbrook without walls”. It is remarkable just how little doctors know or care about people in pain. Typically, I have to get the doctor to diagnose my clients pain properly. The treatments provided are minimal. It reminds me of an old movie Oliver, where children in a large hall have to wait quietly while a nasty man throws some gruelish oatmeal from a giant vat into each of their bowls. What is even more remarkable to me is how people in pain put up with parlous pain care.

It’s money, money and more money for the Dr’s that do these procedures. Oh and the monthly UA tests too, more money.
I have heard that some doctors hold the injections over a patients head and demand they get them in order to receive opioids for pain.
A pain doctor I know, won’t give patients the effective doses of pain meds to try and force these shots on them. Just keep them about 2 pills short so the person stays at a 6 or 7 pain level, when they have been down to a 3 on correct doses. The office is run by an out patient surgery center. What do you think about this?

I had a nerve block for back paini a number of years ago. It worked so well that, when a friend asked “How is your back doing?” I responded “Why?” before I remembered I used to have such terrible back pain.
Once I read about the negatives of these injections, despite the unqualified success of the shot, I have never had another one. It is too scary, too many side effects.
As to sedation before and patients having benefit, one has to wonder how much the sedation’s lingering effects have to do with not being fully aware of pain.

New consciousness is needed by researchers, practitioners,
government and the public, if we are to get beyond the limitations of parlous pain care today. Unfortunately, many researchers and practitioners hold on to their cherished assumptions and believe they are on the right track. They believe with enough time and money their solutions cannot fail. So whether it is nerve blocks or anti-convulsants these treatments have die hard supporters- “true believers” who see no need to change their consciousness or tread new paths-and so we are stuck on limited solutions and people suffering from too much pain.